Iowa Senate Bill SSB1029

Iowa 2025-2026 Regular Session

• Introduced: 1/22/25
• Refer: 1/22/25

Caption

A bill for an act relating to certain cost controls for health care services.(See SF 319.)

Summary

This bill creates a new chapter in Iowa law, titled the Patients Right to Save Act, aimed at lowering health care costs by requiring providers and health plans to disclose and use discounted cash prices for covered services. Health care providers would have to establish, post, and update discounted cash prices for specific services, and inform patients in advance that they may choose to pay that price. The bill also requires health plans to disclose the average allowed amount for covered services and to allow covered persons to receive credit toward deductibles and other cost-sharing when they pay a discounted cash price that is below that average amount. The bill also addresses prescription drugs, out-of-network referrals, and claim handling. It would require health carriers to make formulary out-of-pocket drug pricing available to pharmacists, prohibit contracts that prevent providers from offering or disclosing discounted cash prices, and require plans to credit certain generic-drug purchases toward cost-sharing. It further creates a savings incentive program under which members can share in the savings when they choose lower-cost care, and it directs the Department of Administrative Services to study whether similar incentives should be offered to state employees and retirees.

Impact

The bill would add a new chapter 514M to the Iowa Code and amend the insurance unfair claims practices provisions in chapter 507B to treat improper denial of claims under the new chapter as a regulated insurance violation. It would impose new disclosure, notice, and cost-credit requirements on health carriers and health care providers, including hospitals and other licensed facilities, and would create new patient rights to use cash pricing and receive deductible or cost-sharing credit. It also directs the Department of Administrative Services to evaluate and potentially implement a savings incentive and deductible credit program for state employee health coverage by the 2027 open enrollment period.

Sentiment

The available record shows no committee transcript, recorded vote, or formal opposition in the provided materials, so there is no documented floor or committee debate to gauge sentiment. Based on the bill text, the measure appears to be framed as a consumer-facing cost-control and transparency proposal, suggesting a generally pro-patient, pro-savings intent. The absence of recorded votes or discussion prevents a more specific assessment of support or resistance among legislators or stakeholders.

Contention

The main points of potential contention are likely to be the administrative and contractual burdens placed on providers and insurers, and the extent to which the bill interferes with existing network contracting and claims administration. Providers may object to mandatory public posting of discounted cash prices, notice requirements, and restrictions on contract terms that limit cash pricing disclosure. Health carriers may also object to the requirement to credit cost-sharing based on cash prices, to disclose average allowed amounts, and to support a savings incentive program that shares savings with members and possibly third parties. Another possible issue is the bill’s treatment of claim denials under the new chapter, which could increase disputes and regulatory oversight.